American Journal of Epidemiology Advance Access originally published online on August 30, 2006
American Journal of Epidemiology 2006 164(7):672-681; doi:10.1093/aje/kwj289
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Original Contribution |
Diabetes Risk Associated with Use of Olanzapine, Quetiapine, and Risperidone in Veterans Health Administration Patients with Schizophrenia
1 Department of Pharmacy Administration, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
2 Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
3 Department of Veterans Affairs, Pharmacy Benefits Management Strategic Healthcare Group, Hines, IL
4 Center for Health Quality, Outcomes, and Economic Research, Veterans Health Administration, Bedford, MA
5 Department of Health Services, School of Public Health, Boston University, Boston, MA
6 Psychiatry Service, VA Ann Arbor Healthcare System, Ann Arbor, MI
7 Department of Psychiatry, Medical School, University of Michigan, Ann Arbor, MI
8 Cooperative Studies Program Coordinating Center, Edward Hines, Jr. VA Hospital, Hines, IL
9 Center for Health Statistics, Department of Psychiatry, College of Medicine, University of Illinois at Chicago, Chicago, IL
Correspondence to Dr. Bruce L. Lambert, Department of Pharmacy Administration, University of Illinois at Chicago, 833 South Wood Street (M/C 871), Chicago, IL 60612-7231 (e-mail: lambertb{at}uic.edu).
To evaluate risk of new-onset type 2 diabetes associated with use of selected antipsychotic agents, the authors conducted a new-user cohort study in a national sample of US Veterans Health Administration patients with schizophrenia (and no preexisting diabetes). The authors studied 15,767 patients who initiated use of olanzapine, risperidone, quetiapine, or haloperidol in 1999–2001 after at least 3 months with no antipsychotic prescriptions. Patients were followed for just over 1 year. New-onset diabetes was identified through diagnostic codes and prescriptions for diabetes medication. In Cox proportional hazards regression adjusting for potential confounders, with patients initiating haloperidol use designated the reference group, diabetes risk was increased equally with new use of olanzapine (hazard ratio (HR) = 1.64, 95% confidence interval (CI): 1.22, 2.19), risperidone (HR = 1.60, 95% CI: 1.19, 2.14), or quetiapine (HR = 1.67, 95% CI: 1.01, 2.76). Diabetes risks were higher in patients under age 50 years. When data were reanalyzed with prevalent-user cohorts and matched case-control designs, results were similar, with slightly less elevated risk estimates. Assuming that the observed associations are causal, approximately one third of new cases of diabetes may be attributed to use of olanzapine, risperidone, and quetiapine in patients taking these medications. Prescribers should be mindful of diabetes risks when treating patients with schizophrenia.
antipsychotic agents; case-control studies; cohort studies; diabetes mellitus; pharmacoepidemiology; schizophrenia; veterans
Abbreviations: VHA, Veterans Health Administration
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